Healthcare Provider Details

I. General information

NPI: 1922536648
Provider Name (Legal Business Name): ALYZZA DE LA UZ FORTE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JOHN F KENNEDY DR 311
ATLANTIS FL
33462
US

IV. Provider business mailing address

303 HARDWOOD PT
JUPITER FL
33458-8349
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0353
  • Fax:
Mailing address:
  • Phone: 305-283-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2891322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: